Courtesy of Dr. Carlos Fava. The presence of chronic obstructive pulmonary disease (COPD) is a criterion for which patients are ruled out for surgery and proposed as candidates for its current alternative, transcatheter aortic valve replacement (TAVR). A minimalist strategy could benefit this patient group, given the use of conscious sedation instead of general anesthesia. …
Incidence of ‘Slow Flow’ After Rotational Atherectomy of Calcified Arteries
Courtesy of Dr. José Álvarez ‘Slow flow’ may complicate a rotational atherectomy procedure, especially when done on severely and extensively calcified lesions and small caliber vessels. Although its incidence is between 3% and 27%, its cause remains unclear, and it is thought that platelet antiaggregation induced by burr rotation speed may be behind it. …
Follow-up at 10 years for invasive vs. conservative strategy for non-ST-segment elevation infarction
The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), with elevated markers such as cardiac troponin T. The absence of long-term benefit of an early invasive strategy at 1 and 5 years had already been reported.…
Bivalirudin reduces bleeding rate in carotid stenting
Courtesy of Dr. Carlos Fava Bivalirudin has been shown to reduce bleeding in carotid stenting and maintain its efficacy. Even though carotid stenting has shown benefits, these remain unclear. With this in mind, four studies were analyzed (one randomized) including 7,784 patients undergoing carotid stenting with unfractioned heparin vs. bivalirudin. No difference was…
Promising Outcomes of Overlapping Stents in Patients Undergoing Bioresorbable Scaffold (BRS) Implantation
Courtesy of Dr. Guillermo Migliaro. In regular clinical practice, overlapping stents are reported in up to 30% of patients undergoing coronary angioplasty, especially due to very long lesions requiring implantation of multiple stents or dissection after the implantation of a first stent. In bare metal stent era, overlapping was associated with unfavorable clinical outcomes…
Dual antiaggregation time and death by bleeding
Despite the fact that some randomized studies and meta-analyzis have suggested prolonged dual antiaggregation could be associated to increased death rate, the underlying mechanism remains unclear. It is only logical to assume that if there was an actual increase in mortality associated to prolonged antiaggregation, this should be due to bleeding; however, no studies have…
Primary angioplasty and multivessel lesions: how should we proceed?
Courtesy of Dr Carlos Fava. The association of primary angioplasty with multivessel lesions is not infrequent and has been analyzed in various studies and meta-analyses. However, the proper course of action remains unclear. According to this study, fractional flow reserve (FFR) could better define the ischemic impact of lesions and help with the identification of…
TAVR in Intermediate-Risk Patients: Is It as Effective as Surgical Aortic Valve Replacement?
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has proven to be beneficial for extreme- and high-risk patients. It is also increasingly used in intermediate-risk patients, and it has been hinted at for low-risk patients. However, different sectors in the medical community still challenge the existence of real TAVR benefit. This assessment consisted…
Is Impella an option in high-risk angioplasty?
Courtesy of Dr. Carlos Fava. Provitional ventricular assist devices are increasingly used in high-risk angioplasties, particularly those involving unprotected left main coronary artery (LMCA) with defective ventricular functioning. However, so far its true role has not been well-studied. This study analyzed 127 consecutive patients in the USpella registry from 2008 to 2015. These subjects underwent high-risk…
Is it safe to perform percutaneous treatment in acute pulmonary thrombosis?
Courtesy of Dr. Carlos Fava Massive and submassive pulmonary embolism (PE) has traditionally been treated with anticoagulation and catheter direct thrombolysis (CDT), but the safety and efficacy of this treatment has not been yet properly assessed. The study analyzed 137 patients presenting acute PE massive or submassive. All patients received CTD associated to heparin…